Provider Demographics
NPI:1508187709
Name:O'BRIEN, KEVIN T (DO)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:T
Last Name:O'BRIEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:10125 W COLONIAL DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-4211
Mailing Address - Country:US
Mailing Address - Phone:407-290-9355
Mailing Address - Fax:407-295-0033
Practice Address - Street 1:10125 W COLONIAL DR
Practice Address - Street 2:SUITE 102
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-4211
Practice Address - Country:US
Practice Address - Phone:407-290-9355
Practice Address - Fax:407-295-0033
Is Sole Proprietor?:No
Enumeration Date:2010-06-22
Last Update Date:2013-09-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS 11916208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics